Borderline Personality Disorder: A Case of Suffering, Drama and Hope

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Posted in: Parenting Concerns, Teenagers, You & Your Family, Young Adults

Topics: Mental Illness + Psychiatric Disorders

There’s an understandable tendency to portray Borderline Personality Disorder (BPD) in films. Silver Linings Playbook, Fatal Attraction, and Girl Interrupted are just a few. 

It makes sense. High drama, stormy interpersonal relationships, drugs, sex, self-destruction – what could be more compelling?  

But for the individual and their family, Borderline Personality is never merely the stuff of movies.  It’s an incredibly painful psychiatric syndrome that remains poorly understood despite its prolific appearances on the silver screen. And yet, as I have worked with teens and adults struggling with this problem, I’ve learned that there’s always reason for hope.  

What is Borderline Personality Disorder?  

Like most personality disorders, Borderline Personality Disorder (BPD) is a condition in which thoughts, feelings and behavior cause significant challenges that negatively affect personal experience, relationships with others, and one’s ability to function in multiple facets of life.   

This disorder affects up to 5% of the population, and research indicates that symptoms likely begin in adolescence. Some of the most startling symptoms include suicide attempts and tendencies towards non-suicidal self-injury (NSSI) such as cutting. Sadly, patients with BPD account for 9 to 33% of all suicides, with a lifetime suicide rate of 8%.  

Those living with BPD generally struggle with relationships, self-image, identity and impulsivity. To meet diagnostic criteria based on the American Psychiatric Association and the Diagnostic and Statistical of Mental Disorders, an individual must have at least 5 of the following features:  

  1. Frantic attempts to avoid real or imagined fears of abandonment. They have an intolerance of being alone and fear that those close to them will leave, cannot be trusted, and will not be available for support.  
  2. Unstable, intense relationships. These may be volatile, unpredictable, and laced with frequent disappointment and feelings of rejection. 
  3. Unstable sense of self. There is a profound identity disturbance, low self-esteem, and confused or conflicted self-image. Many individuals will also have significant questions about their values, friends, ideals, perceptions and/or sexual identity. 
  4. Impulsivity. The individual with BPD makes rash and risky decisions based not on logical reasoning, but on outbursts of emotion. 
  5. Self-injurious behavior. There are many ways teens or young adults may harm themselves, including suicide attempts, cutting, shoplifting, promiscuous sex, bulimic episodes, or driving recklessly. 
  6. Emotional instability. Many individuals will experience marked mood shifts from irritability to explosive anger after seemingly minor perceived infractions. They may also experience intense depression or anxiety.  
  7. Chronic feelings of emptiness. There is often a hollow feeling of boredom.  
  8. Dissociation and feelings of detachment. Many individuals will have the unusual sensation of being in a dream-like state or even not being “in their body.” 

The world is perceived in black and white terms, and both others and one’s own self can be viewed as the victim or victimizer. Because these symptoms are so interpersonally severe, even those who are closest to someone with these symptoms may distance themselves from that individual. This plays into the pervasive fear, and self-fulfilling prophesy, of abandonment.  

Despite all of this, many individuals with BPD can function well under structured situations. Despite their vulnerabilities, they are often highly sensitive and caring of others. They demonstrate a keen capacity for empathy, compassion, and a deep desire to help others, just as they hope that they themselves can be supported.  

Treatment for BPD 

The good news is that Borderline Personality Disorder can be treated. While there is less research on teenagers, 85% of adults with BPD no longer suffer from the disorder after 10 years, and this figure rises to 99% after 16 years. 

Since the problem typically begins in adolescence, the earliest intervention possible is best. Here’s what works:  

  1. Psychotherapy: The most effective treatments are Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), and later in the course, psychodynamic psychotherapy. 
  2. Mindfulness meditation is extremely effective in quelling overwhelming emotions and impulsivity, and is often combined with other forms of psychotherapy.  
  3. Group Therapy: Many find that a supportive group is incredibly valuable. Group therapy can help boost an individual’s self-esteem as they find that their thoughts, feelings and behavior may be shared by others.  
  4. Treatment of Substance Use Disorders: Unfortunately, many turn to alcohol or drugs for immediate relief or to harm themselves. The risk of suicide rises with substance use, and the potential for addiction is high. Thus, substance abuse treatment programs are incredibly helpful.  
  5. Hospital Treatment: It’s not unusual for teens or young adults to require brief residential or inpatient units for care, support and, above all, safety 
  6. Medications: While there is no specific medication for Borderline Personality Disorder, many medicines can be used to help quell depression, anxiety, impulsivity and self-harm.  
  7. Family Therapy: For teens living at home or young adults living near their families, this option can be extremely valuable for fostering a supportive, structured, and caring family who understands and appreciates the struggles of the patient with BPD.  

Borderline Personality Disorder is without question treatable.  It takes time – healing is a marathon, never a sprint – but with early intervention, compassionate support, and appropriate treatment, individuals living with BPD can improve and ultimately thrive.  

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Gene Beresin

Gene Beresin, Executive Director

Gene Beresin, MD, MA is executive director of The MGH Clay Center for Young Healthy Minds, and a staff child and adolescent psychiatrist at Massachusetts General Hospital. He is also...

To learn more about Gene, or to contact him directly, please see Our Team.